1. The Role of KNH/UON in Accelerating the Achievement of MDGs 5 and 4 1 MNCH Symposium 10 January 2013 Dr. Gathari Ndirangu Reproductive Health

2. MDG 5 in Kenya MDG 5 is off target –MMR target: 147/100,000 live births by 2015 –Universal access to RH –Current MMR: 488/100,000 live births*, up from 414 in 2003** Newborn part of MDG 4 has stagnated –Neonatal mortality rate 31/1000 live births* –60% of IMR Commendable progress in the other MDGs (especially 1, 2, 3) *KDHS 2008-09 **KDHS 2003

3. Socioeconomic Determinants of Maternal Mortality Illiteracy, poverty and poor women empowerment Pregnancy too soon, too frequent, too many Inadequate access to RH/MNH/FP services Delivery under unskilled care Limited accountability at all levels

4. Policy Environment

5. KNH’s Strengths to Accelerate Achievement of MDG5 Strategic objectives to fulfil national mandate, vision and mission –To improve quality specialized reproductive healthcare –To reduce maternal and perinatal morbidity and mortality –To enhance training and research –To contribute to national RH planning and policy formulation –To strengthen institutional linkages and collaboration –To contribute to corporate social responsibility and improve on hospital image

6. MNH Strategic Objectives Reduce maternal and perinatal morbidity/mortality –Service provision from primary to tertiary care –PMTCT program Training and research –Graduate and undergraduate levels, paramedical –Vibrant and respected research community –Translation of research into policy and practice Contribute to national RH planning and policy formulation Institutional linkages and collaboration, including PPP

7. Challenges Heavy client load (outstrips capacity) –Non-booked ANC clients (~60%) –Late referrals High MMR –1223/100,000 LB (Jan-Nov 2012) High NMR 116/1000 LB (Jan-Dec 2012) –Prematurity –NN Sepsis –Term RDS –Birth asphyxia

8. KNH’s Opportunities for Improving MNH Indicators Highly trained workforce Favorable policy environment –National referral hospital –Devolved governance –Strengthen lower tier health care facilities –Effective knowledge and skill transfer –Mentorship –Timely and supportive feedback to referring HCFs –Satellite health care facilities –Modern technology

9. KNH’s Opportunities for Improving MNH Indicators Proactively creating modalities to realize full potential in MNH services –Advocacy –Participation in national RH planning including MPDSR –Training –Research –Collaboration including PPP Provision of full range of FP services (LAPM) Timely reporting to the national HMIS for national planning

10. Threats Political interference and uncertainty Poverty Inadequate financial resources Commodity insecurity/inadequate equipment Increased litigation Industrial strife Inadequate health workforce

11. National Vision 2030 MNH target MMR- 113/100,000 LB (77% reduction) –From 1223 to 281/100,000 LB NMR- 13/1000 LB (59% reduction) –From 116 to 47/1000 LB Together, we are up to the task!